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Billing systems: Look beyond claims, invoices

Everything in an HME business is connected, so having an IT system that gives providers a panoramic view of their operation makes more sense than having siloed systems designated for specific departments, automation proponents say.

Given the advanced functionality of modern technology and the affordability of cloud computing, even the smallest companies can afford to have a multi-functional, enterprise-wide system. Automating functions across the board is a bona fide upgrade from the hybrid manual-electronic processes that exist in HME companies, says Ted Jones, president and CEO of Fresno, Calif.-based BFlow.

“I’ve worked in fast-paced hospital environments with energized staff and infrastructure and HME is overlooked and underserved,” he said. “What I’ve seen in the HME environment is binders everywhere, which is a sign of distracted workflow. By going to full automation, providers have a binder-less system that offers a real-time, in-depth view of what is going on with their business.”

Jones’ analysis revealed that manual processes for claims management entail 44 steps from intake to adjudication. That process relies heavily on the biller’s memory, he said.

Business management—commonly referred to as business intelligence—is a platform that covers more than just billing functionality. It encompasses collections, purchasing, accounts payable and human resources, tying all the processes together, said Esther Apter, president of Suffern, N.Y.-based MedForce Technologies.

“Automation equals efficiencies—that is a simple equation,” she said. “The most inefficient part of any process tends to be in the handoffs of work from one person to another or from one department to another. A process manager that interacts with all provider systems and automates the handoffs creates a significant noticeable increase in efficiencies.”

The benefits to choosing a system that offers front-to-back business management are transparency, ease of use, and often some cost savings, said Chris Dobiesz, president of Davison, Mich.-based Universal Software Solutions.

“If a provider is using a billing system that also has customer service and inventory components that they rely on, then they should continue to invest in that solution as it is enhanced and expanded,” he said. “The biggest mistake we see providers make is repeated unwillingness to break apart an existing business process to rebuild it using newer, more efficient workflows or tools that have been developed in their software.”

To be sure, many HME providers have “a spider web of information systems” that are utilized across their business, said Joey Graham, vice president of operations for Charlotte, N.C.-based Prochant.

“The more integration providers can establish across these systems, the more they are able to streamline processes and ensure data accuracy,” he said. “One major, current example is the integration of document management systems with front-office workflow systems. This allows providers to track a virtual ‘chart’ throughout the intake process through fulfillment and on to billing and collections.”

While BI is a common and powerful tool, it can also be easily constrained by data scattered across multiple systems, said Patty Harrison, HME content creator for Billings, Mont.-based Computers Unlimited.

“Robust integrated business management platforms allow for much wider analysis and perspective—perspectives that cannot be seen when systems, and the data they gather, are bunched up in silos,” she said. “An integrated system prevents business processes fragmentation because the entire business process is managed under a single system, not two or more, which can lead to inefficiencies, data duplication and human errors. A single system also makes it easier to manage compliance issues because data transactions are stored and maintained centrally, making it easier to manage auditing and compliance matters.”

Leveraging automation

Rob Boeye, HME executive vice president for Lawrenceville, Ga.-based Brightree, says the insight gained from looking across the financial landscape can be used to improve the patient and referral source experience.

“With the compression in the industry, you need to differentiate yourself with patients and referral sources,” he said. “The business management platform gives you visibility into all areas of the operation, which provides a deeper understanding of improving service levels. I recommend using management software that improves patient intake from referrals, has a good inventory management system, claims filing that allows auto response and audits and the big one is analytics.”

Because cash flow is the lifeblood of the company, analytics charts key performance indicators regarding collections, days outstanding levels and resupply efficiencies. And while cash flow is the lifeblood, inventory is the heart of the HME business, said Wayne Bailey, director of client services for Bonafide Management Services of Thousand Oaks, Calif.

“All business functions must tie directly back to inventory control and management,” he said. “Once you put inventory at the heart of your business software, you can establish a program flow that ensures maximum margins. The flow takes into account and adjusts in real time for the cost of the item, reimbursement on the item, CPT code, modifier, compliance documents and payer requirements. With the correct workflow based on inventory, an HME provider can turn a profit and optimize business operations given market conditions.”

Kent Barnes, director of marketing for Brentwood, Tenn.-based Team DME!/Spectrum Software echoes the assertions that an integrated system boosts customer service to an optimal level.

“When customers are unable to quickly get information on their order status, can’t get issues resolved in a timely manner, or must frequently deal with products being out of stock, they will be less satisfied and less likely to continue purchasing from you,” he said. “An integrated software system ensures that customers have the right information and customer experience and that your employees have the instantaneous access to all the customer information they need to service, sell to your customers and make sure you will get paid.”

The integration points and whether the application can accept and provide electronic data to ensure more accuracy in sharing patient data should be considered, said Kimberly Commito, director of product management, Home Care Solutions, for Lisle, Ill.-based Mediware Information Systems.

“Of course, this brings with it a responsibility to ensure that the application is HIPAA compliant and secure in general,” she said. “The ability to accept various forms of electronic payment should be considered as well…credit card, debit card and electronic checks are important to consider. How the vendor handles integrations with payment platforms or partners is important in ensuring that there is a safe, secure and efficient way to collect patient payments for co-pays and balances.”

Another option for providers is to consider a partner for billing and collections, said Bruce Gehring, senior vice president of development, Allegiance Group in Overland Park, Kan.

“By having a partner to do your billing and collections, you can eliminate the need to manage multiple vendor relationships so you can concentrate on your operations and investigate ways to boost your revenue,” he said. “The most important factor to consider is the philosophy of their billing partner. The growth of an HME business depends on repeat customers. Any partner is an extension of its reputation, so the software/system should be a true partner—following the HME’s business rules and treating its customers with respect.”